Proximal humerus fractures are most commonly repaired with open reduction and internal fixation using plates and screws attached via bi-cortical or uni-cortical fixation. The preferred method to gain access to the fracture site is by making a large incision through the skin and muscles. Once the fracture has been exposed, the fragments of bone are approximated to the plate, including fragments that are attached to muscles via tendons. These muscles (e.g., rotator cuff) are attached to the plate via suture holes designed into it. Problems arise when the plate is first attached to the bone since it is difficult to pass the sutures between the plate and the bone. Thus, manufactures have provided bone plates with suture holes including undulations or suture-clearance recesses or lateral channels formed into the bottom surface and the edge of the plate and placed in relative proximity with corresponding suture holes such that a straight or curved suture needle and attached suture material may be passed through the hole even when the plate is fixed to the bone. This solution still presents challenges during surgery as there is insufficient space or clearance between the bone plate and the bone. Additionally, the superior screws often have the problem of exiting the humeral head superiorly, thus these screws must be able to be adjusted inferiorly to be directed completely into the humeral head.
The present invention seeks to remedy these problems. The object of the invention is to provide an internal fixation system with a plate which provides the surgeon with flexibility, ease of use, and operational efficiency such that a suture can be easily and quickly passed through a suture hole.
Another object of the invention is to provide a bone plate that supports both unidirectional and surgeon-directed or omnidirectional fixation of the screws relative to the plate.